Toward Integrated Treatment for Co-Occurring Borderline Personality Disorder and Eating Disorders: A Clinician Perspective.

Abstract

Objective: It is common practice in Australia for co-occurring borderline personality disorder (BPD) and eating disorders (ED) to be treated separately. The objective of this research was to review features these disorders share, evidence-based approaches used for treating these disorders in isolation, clinicians' experiences of delivering treatment for co-occurring BPD and ED, and finally to explore integrated approaches to treating this dual diagnosis.

Method: A qualitative approach was used to examine interview transcripts of 10 clinicians employed at specialist outpatient services for severe BPD or severe ED. Interview transcripts were analyzed using thematic analysis.

Results: Nominated features shared by BPD and ED were emotion dysregulation, impulsivity, and interpersonal difficulties. Clinicians endorsed a range of therapeutic approaches for this dual diagnosis patient group, as well as an eclectic approach utilizing a combination of treatment features. Most clinicians proposed an ideal program duration of 6-12 months, with group and individually focused therapy complementing one another to address underlying behavioural drivers and confer lasting clinical benefits.

Discussion: This study distills the importance of adopting integrated treatments for people with this dual diagnosis to optimize treatment outcomes. Future research could include soliciting client perspectives on using an integrated treatment approach for this dual diagnosis and trials of this approach to assess acceptability, feasibility, and longer-term outcomes.

Public significance statement: This study highlights the merit of concurrently addressing the complex interplay between EDs and BPD via an integrated treatment approach. Streamlining the therapeutic approach can address underlying features of these disorders, improve clinical formulation, and optimize patient outcomes.